Cs. Cina et al., Kommerell's diverticulum and aneurysmal right-sided aortic arch: A case report and review of the literature, J VASC SURG, 32(6), 2000, pp. 1208-1214
Citations number
35
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Right-sided aortic arch is a rare variant of the thoracic vascular anatomy
that may be accompanied by an aberrant origin of the left subclavian artery
. We report a true aneurysm of the distal arch and descending thoracic aort
a in a patient with right-sided arch and review previous descriptions of an
eurysms of anomalous right-sided aortas. In our patient, the left subclavia
n artery originated at the junction between the distal arch and the descend
ing thoracic aorta located in the right chest and was aneurysmal (Kommerell
's diverticulum); the thoracic aorta was also aneurysmal. Extra-anatomic le
ft subclavian-to-carotid transposition was performed before the intrathorac
ic procedure. Subsequently, a right thoracotomy provided adequate exposure
for repairing the aortic aneurysm and oversewing the aneurysmal origin of t
he subclavian artery. Because the distal aortic arch was involved, deep hyp
othermia and circulatory arrest were used, Only five previous instances of
true aneurysms of a right-sided aortic arch have been reported; four of the
se patients underwent operative repair (via bilateral thoracotomy, median s
ternotomy, or right thoracotomy). We believe that a right thoracotomy provi
des good exposure and avoids the morbidity associated with bilateral thorac
otomy. The reconstruction of the subclavian artery has not previously been
reported in this setting. Performing subclavian reconstruction as an extrat
horacic procedure before the intrathoracic repair would be expected to redu
ce the subsequent risk of distal ischemia or subclavian steal without incre
asing the overall morbidity associated with the procedure.